Same-day initiation of oral pre-exposure prophylaxis among gay, bisexual, and other cisgender men who have sex with men and transgender women in Brazil, Mexico, and Peru (ImPrEP): a prospective, single-arm, open-label, multicentre implementation study
Authors: Valdiléa G Veloso, Carlos F Cáceres, Brenda Hoagland, Ronaldo I Moreira, Hamid Vega-Ramírez, Kelika A Konda, Iuri C Leite, Sergio Bautista-Arredondo, Marcus Vinícius de Lacerda, José Valdez Madruga, Alessandro Farias, Josué N Lima, Ronaldo Zonta, Lilian Lauria, Cesar Vidal Osco Tamayo, Hector Javier Salvatierra Flores, Yovanna Margot Cabrera Santa Cruz, Ricardo Martín Moreno Aguayo, Marcelo Cunha, Júlio Moreira, Alessandra Ramos Makkeda, Steven Díaz, Juan V Guanira, Heleen Vermandere, Marcos Benedetti, Heather L Ingold, M Cristina Pimenta, Thiago S Torres, Beatriz Grinsztejn, J. David Urbaez-Brito, Polyana d'Albuquerque, Claudio Palombo, Paulo Ricardo Alencastro, Raquel Keiko de Luca Ito, João L. Benedetti, Fabio V. Maria, Paula M. Luz, Lucilene Freitas, Kim Geraldo, Monica Derrico, Sandro Nazer, Tania Kristic, Renato Girade, Renato Lima, Antônio R. Carvalho, Carla Rocha, Pedro Leite, Marcio Lessa, Marilia Santini-Oliveira, Daniel R.B. Bezerra, Cleo de Oliveira Souza, Jacinto Corrêa, Marcelo Alves, Carolina Souza, Camilla Portugal, Mônica dos Santos Valões, Gabriel Lima Mota, Joyce Alves Gomes, Cynthia Ferreira Lima Falcão, Fernanda Falcão Riberson, Luciano Melo, Talita Andrade Oliveira, Agnaldo Moreira Oliveira Júnior, Bruna Fonseca, Leonor Henriette Lannoy, Ludymilla Anderson Santiago Carlos, João Paulo Cunha, Sonia Maria de Alencastro Coracini, Thiago Oliveira Rodrigues, Emília Regina Scharf Mettrau, Kelly Vieira Meira, Heder Tavares, Ana Paula Nunes Viveiros Valeiras, Taiane Miyake Alves de Carvalho Rocha, Alex Amorim, Patrícia Sabadini, Luiz Gustavo Córdoba, Caio Gusmão, Erika Faustino, Julia Soares da Silva Hansen, Agatha Mirian Cunha, Neuza Uchiyama Nishimura, Jaime Eduardo Flygare Razo Prereira Santos, Aline Barnabé Cano, Willyam Magnum Telles Dias, Magô Tonhon, Tania Regina Rezende, Alex Gomes, Eloá dos Santos Rodrigues, Maria das Dores Aires Carneiro, Alexandre Castilho, Mariana Carvalho, Dulce Diaz-Sosa, Centli Guillen-Diaz-Barriga, Lorena Hernández, Rebeca Robles, Maria Elena Medina-Mora, Marcela González, Ivonne Huerta Icelo, Araczy Martinez Davalos, José Gomez Castro, Luis Obed Ocampo Valdez, Fernanda Ramírez Barajas, Verónica Ruiz González, Galileo Vargas Guadarrama, Israel Macías, Jehovani Tena Sánchez, Juan Pablo Osuna Noriega, H. Rodrigo Moheno M, Jorge M. Bernal Ramírez, Víctor Dante Galicia Juarez, Gerardo Vizcaíno, Francisco Javier Arjona, Gino Calvo, Silver Vargas, Oliver Elorreaga, Ximena Gutierrez, Fernando Olivos, Damaris Caviedes, Daniella Adriazola, Eduardo Juárez, Gabriela Mariño, Jazmin Qquellon, Francesca Vasquez, Jean Pierre Jiron, Sonia Flores, Karen Campos
Journal: The Lancet HIV (2022)

Although gay, bisexual, and other cisgender men who have sex with men (MSM) and transgender women have the highest HIV burden in Latin America, pre-exposure prophylaxis (PrEP) implementation is poor. We aimed to assess the feasibility of same-day oral PrEP delivery in Brazil, Mexico, and Peru.Implementation PrEP (ImPrEP) was a prospective, single-arm, open-label, multicentre PrEP implementation study conducted in Brazil (14 sites), Mexico (four sites), and Peru (ten sites). MSM and transgender women were eligible to participate if they were aged 18 years or older, HIV-negative, and reported one or more prespecified criteria. Enrolled participants received same-day initiation of daily oral PrEP (tenofovir disoproxil fumarate [300 mg] coformulated with emtricitabine [200 mg]). Follow-up visits were scheduled at week 4 and quarterly thereafter. We used logistic regression models to identify factors associated with early loss to follow-up (not returning after enrolment), PrEP adherence (medication possession ratio ≥0·6), and long-term PrEP engagement (attending three or more visits within 52 weeks). This study is registered at the Brazilian Registry of Clinical Trials, U1111-1217-6021.From Feb 6, 2018, to June 30, 2021, 9979 participants were screened and 9509 were enrolled (Brazil n=3928, Mexico n=3288, and Peru n=2293). 543 (5·7%) participants were transgender women, 8966 (94·3%) were cisgender men, and 2481 (26·1%) were aged 18-24 years. There were 12 185·25 person-years of follow-up. 795 (8·4%) of 9509 participants had early loss to follow-up, 6477 (68·1%) of 9509 were adherent to PrEP, and 5783 (70·3%) of 8225 had long-term PrEP engagement. Transgender women (adjusted odds ratio 1·60, 95% CI 1·20-2·14), participants aged 18-24 years (1·80, 1·49-2·18), and participants with primary education (2·18, 1·29-3·68) had increased odds of early loss to follow-up. Transgender women (0·56, 0·46-0·70), participants aged 18-24 years (0·52, 0·46-0·58), and those with primary education (0·60, 0·40-0·91) had lower odds of PrEP adherence. Transgender women (0·56, 0·45-0·71), participants aged 18-24 years (0·56, 0·49-0·64), and those with secondary education (0·74, 0·68-0·86) had lower odds of long-term PrEP engagement. HIV incidence was 0·85 per 100 person-years (95% CI 0·70-1·03) and was higher for transgender women, participants from Peru, those aged 18-24 years, Black and mixed-race participants, and participants who were non-adherent to PrEP.Same-day oral PrEP is feasible for MSM and transgender women in Latin America. Social and structural determinants of HIV vulnerability need to be addressed to fully achieve the benefits of PrEP.Unitaid, WHO, and Ministries of Health in Brazil, Mexico, and Peru.For the Portuguese and Spanish translations of the abstract see Supplementary Materials section.